Provider Demographics
NPI:1184801631
Name:EAST TENNESSEE PRIMARY CARE, INC
Entity type:Organization
Organization Name:EAST TENNESSEE PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WINNIFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNBAR-DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-778-5584
Mailing Address - Street 1:PO BOX 80982
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414
Mailing Address - Country:US
Mailing Address - Phone:423-495-4349
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:3300 WILCOX BLVD.
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411
Practice Address - Country:US
Practice Address - Phone:423-803-9180
Practice Address - Fax:423-803-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44104835OtherTENNCARE SELECT
TN4104835OtherBLUE CROSS OF TENNESSEE
TN5487562OtherCIGNA
TNTN0101OtherUHC OF THE RIVER VALLEY
TN5487562OtherCIGNA
TN4104835OtherBLUE CROSS OF TENNESSEE